Research Spotlight: Dr Lisa Danquah
Lecturer in Global Health at HCRI, Dr Lisa Danquah, talks about developing and implementing a contact tracing application in Sierra Leone in response to the Ebola Virus Disease, building disability-inclusive water, sanitation and hygiene (WASH) interventions, and tackling emerging infectious diseases.
Tell us about your research.
My research interest is in the control of emerging infectious diseases during disease outbreaks, with a particular focus on viral haemorrhagic fevers, namely Ebola Virus Disease. I am interested in applying digital health technologies through smartphone applications, or more commonly, mobile health (mHealth) approaches to improve real-time disease detection, disease surveillance, and response during humanitarian emergencies, particularly for disease outbreaks. As part of this work, my interest is in assessing the challenges and weaknesses of traditional approaches, such as paper-based methods and how novel methods through smartphones and other digital health technologies can be applied to improve outbreak preparedness and response activities in a timely and efficient manner, which is often challenging in low and middle-income settings. I am also interested in the rigorous evaluation of these systems and processes in these settings by applying trial designs to evaluate their effectiveness, for example, cluster randomised trials.
What types of studies have you worked on?
I have worked on different studies in these areas, including a study to improve the effectiveness of Ebola contact tracing and monitoring through the design of a smartphone application during the 2014 – 2016 Ebola Virus Disease outbreak in Sierra Leone. This study was conducted in 2015 and was initially a cluster randomised trial but later changed to a proof-of-concept study due to the decline in Ebola cases. This study aimed to evaluate the feasibility and effectiveness of a smartphone application for Ebola contact tracing and monitoring in the Port Loko District of northern Sierra Leone and compare its effectiveness with the standard paper-based system. I have recently led the design and implementation of a multi-country 14-country project to assess digital tools for event-based surveillance data collection and systems capacities for countries in sub-Saharan Africa, Asia, the Middle East and South-Eastern Europe together with regional disease surveillance networks. In this project, we sought to identify the types of digital approaches utilised for event-based surveillance in these countries, focusing on cross-border areas and addressing the importance of the interaction of animals, human health, and the environment through the consideration of One Health that incorporates these aspects.
What other studies have you worked on in global health?
I have worked on various field-based studies to include epidemiological, mixed methods and implementation research studies in several low and middle-income countries (LMICs) in sub-Saharan Africa, South and South-east Asia, and the Caribbean. These studies have focused on a diverse range of topic areas to include international eye health and disability research with the aim of improving the evidence base related to eye health and disability in LMICs, and the implementation and evaluation of water, sanitation and hygiene (WASH) interventions in LMICs. The primary focus of which was on disability-inclusive WASH for vulnerable groups. Additionally, I have been involved in formative research to inform the design of behavioural interventions in relation to WASH and the other previously mentioned studies in digital health.
Which disciplines and methods have you applied in your research into global health and why?
I have drawn on different disciplines and applied various methods for the research that I have been involved in. The disciplines include epidemiology, public health, global health, medical statistics, social science, and general areas of research methods and have applied methods and techniques specifically from some of these areas that were most appropriate to address each research project's aims and objectives. The research projects have primarily involved primary data collection in the field setting in countries in the regions outlined. The specific study designs have included cluster randomised trials, nested case-control studies, cross-sectional studies, and follow-up studies. I have also been involved in proof-of-concept studies, process evaluations, mixed methods research study designs, evaluation, and survey research. Additionally, I have been involved in studies using secondary data collection methods, including desk-based research and secondary data analysis.
Can you tell us about your experience in Sierra Leone of working on the Ebola epidemic?
I worked as the Research Coordinator for the London School of Hygiene and Tropical Medicine in 2015 on the Ebola Contact Tracing Study in northern Sierra Leone. The Ebola Contact Tracing Study was a collaboration between the London School of Hygiene and Tropical Medicine (LSHTM), Innovations for Poverty Action (IPA) and the International Medical Corps (IMC). I was in Sierra Leone for nearly a year managing the coordination and implementation of this study in one of the country's worst-affected districts. I worked with other international partners, as mentioned (IPA and IMC) who were also stationed in the country, and we were supported by colleagues in different countries and two London-based Principal Investigators. My role “on the ground” in-country was to ensure that the study met its objectives and was implemented and coordinated as planned. Once data collection had finished, it was to work with the study team to clean and analyse the data and report on the study findings.
What were some of the challenges of conducting research during an outbreak?
My experience during the outbreak was very intense due to the scale and nature of the epidemic and the associated challenges that came with that, meaning that conducting research was time-bound and the pace of work was fast-moving. This situation affected all aspects of the research, from the initial project conception and ethical approval, logistics to travel to the country and settling in, study coordination, training, implementation, data collection and analysis. We had to change our study design due to the decline in Ebola cases, as mentioned previously, and there were other implementation and design issues, for example, technical challenges and the complexity of designing and implementing a system in an emergency context. A short video explaining these issues can be accessed here.
Despite these issues, it was rewarding to conduct epidemiological and implementation research during a humanitarian emergency and contribute to improving the evidence base on implementing digital technologies during humanitarian emergencies, and this is an experience that I will never forget!
What are your future research plans?
I plan to continue my research in assessing and evaluating digital technologies' role in response to emerging disease outbreaks, particularly in relation to contact tracing. Given the current COVID-19 pandemic, this has heightened the need to focus on using innovative approaches and methods to tackle the global threat posed by emerging infectious disease outbreaks and the identification and control of novel pathogens. There is a critical need to respond in an appropriate and timely manner to mitigate their impact. I seek to build on the lessons learnt from implementing a mobile application in an outbreak setting during the Ebola Virus Disease epidemic in Sierra Leone and how the lessons learnt can be applied going forward.